Unspoken complication of childbirth

Cardiff University doctors are on a mission to improve diagnosis times and treatment for women in Wales who suffer anal sphincter injuries in childbirth.

There is currently a large discrepancy between services in Wales and the rest of the UK, with patients in Wales not having routine access to treatments such as physiotherapy, and a large variation in the amount of training and support that is offered to midwives and obstetricians.

By hosting the first MASIC (Mothers with Anal Sphincter Injuries in Childbirth) training day, the first of its kind in Wales, the doctors at Cardiff University’s National Surgical Training Centre for Wales hope to improve awareness amongst clinicians of the full impact of the condition on women and their families, and start the first patient support group for women in Wales to access information and advice.

An anal sphincter (AS) injury commonly affects first-time mothers who give birth vaginally. Approximately 3.7% of child births in Wales result in such injuries with over 10% of mothers who give birth through the birth canal developing some form of faecal incontinence, such as inability to hold wind or stools. There may also be urgency issues and associated anxiety.

Women rarely volunteer information about their injury because of the embarrassment and associated social stigma. They often suffer in silence and are very alone.  Depression, anxiety and a multitude of psychological effects may also impact heavily on a woman with an AS injury.  

The new workshop is designed to build networks of interested clinicians, provide training and developing clear pathways which will allow patients to access investigations and treatments more quickly. Currently it is estimated that it takes 7 years on average for a patient to be diagnosed and referred to an appropriate specialist.

This condition not only affects the woman but has a ripple effect that can damage family relations, bonding and physical contact, not only with the partner but also with the child. Feelings of isolation, degradation and irritability are common for women with faecal incontinence.

The workshop is being clinically lead by Mrs Julie Cornish, Consultant Colorectal Surgeon of Cardiff and Vale University Health Board, and Mrs Nadia Bhal, Consultant in Obstetrics and Gynaecology Cwm Taf University Health Board.

“I attended the launch of the MASIC foundation in London and the most vivid recollection is from listening to a MASIC mum’s story on how living with faecal incontinence affected not only her life, but her partners and her children. As clinicians it is too easy for us to focus on the physical injury but the MASIC workshops allow staff to gain a holistic view of the condition. It has really inspired me to drive service improvement in Wales,” said Mrs Julie Cornish, Consultant Colorectal Surgeon, Cardiff and Vale UHB.

Mrs Nadia Bhal, Consultant in Obstetrics and Gynaecology Cwm Taf UHB, added: “As an Obstetrician with a special interest in Perineal trauma I have been involved in national and international work to deliver training and support for midwives and doctors.  Attending the launch of MASIC was different. Listening to the brave MASIC mother’s stories really moved me.

“MASIC ignited my passion to continue working in raising awareness, provide training in evidence based practice, to do everything we can to prevent these injuries from happening and provide the best level of care for MASIC mothers following childbirth.”